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Thursday, December 15, 2011

On Choosing Pathology and its Compatibility with Motherhood

"What, you are going into pathology? But you actually like to talk to people, you are good with patients. Why would you do that?"

I decided to do pathology at the 11th hour. I already had a rumored slot in ophthalmology - I was looking to stay in my hometown as my ex had recently landed a residency in anesthesia here. At the urgency of my brother-in-law, a first year path resident, I did a month rotation in late fall, before the general residency applications were due but after I had completed my San Francisco match application. Despite enjoying the course and doing well in it I thought "Ha, pathology. That is for complete nerds." At the same time, a voice was nagging in the back of my head about ophthalmology - actually an attending's voice, one I met during a summer rotation in another state. "It's not like it used to be. I see 65, 70 patients a day. Do you think I get to talk to them? No. The techs do. I just look and dictate what goes on the chart and run to the next room. My job satisfaction has plummeted."

Before I get railed on by all the ophthalmologists or ophtho wanna-be's out there, my best friend in med school went into ophthalmology, and she is very happy practicing in a small town, doing lots of surgery, and talking to her patients. I just happened upon a woman in a bad job situation - I realize her opinion was not global. But everything you hear affects what you do, and every one's experience counts for something. I worried over ortho after calling, at the urgency of a male colleague, one of the few older female orthopedics in the state. She said, "If you want a family, don't do it. Do something else." I watched another girl friend start orthopedics, than bail out for radiology.

I admire all of the people that enter primary care, but I was never pulled in that direction. Ironic that I am now somewhat of a generalist in pathology. I do it all at a large metropolitan hospital - lab director, bone marrows, lymph nodes, apheresis, cytology, surgical pathology, frozen sections, traveling to small hospitals and clinics to cover the scope of my practice. So I did become a "primary care pathologist," to use a phrase that someone else coined, but more of a diagnostician than anything else.

Pathology residency was very conducive to starting a family. I had two kids during residency and while in retrospect that was probably more than I and my marriage could handle - when I read about the overnight call and the extent to which my colleagues here have to spend time away from their kids, I feel like I got off lucky. Aside from a few autopsies on weekend call it wasn't so bad. When I entered practice I was awed and fearful of my new responsibility and worked overly hard for the first couple of years, but now I find time to take breaks during the day and do other things. I've gotten into a nice groove. Pathology is feast or famine, and there are days when we get pretty busy, but if there is a school program or class party I can always find someone to cover for me so I can get away for an hour or two, even if it means working late. I imagine this is different from an outpatient practice where you have to show up for clinic if there are patients scheduled, no matter what. Difficult to find coverage unless there is an emergency, and emergency is probably the only reason you would cancel a clinic. My group is 13, including part timers, so it is a rare day that there isn't someone who can function as you, if needed, for a little bit. We all lean on each other so no one feels overburdened. I go to a Christmas program. Another partner needs to help her mom that just broke her hip. Someone needs to get to the bank or post office. Someone needs coverage to get to his son's basketball game. It's certainly not daily, but making the important things that fall short of broken bones in the ED is very do-able.

Most of the time, now that I am four years into practice, I have 8 hour days, even though that often means cramming lunch into 10 minutes. We are all used to that from residency, so not much difference there. I hire someone to get my kids to their after school activities - tennis, dance, etc., and often meet them before the activities are over. My current after school help marveled after she had been carpooling my kids around two weeks. "I tell everyone at my church - she's a doctor and she cooks for her kids! Can you believe it?" I laughed at the stereotype that seems to no longer be universally relevant, especially around here, where we are often begging for recipe ideas. Yes, we have our occasional mac and cheese and fish sticks days, but we sit down at night at the table together and talk about our day. We go over our multiplication tables (They go to 12 these days! I only learned to 10 so I had to brush up) and spelling words. We problem solve daily ethical issues - playground misbehavior they have witnessed, etc. We read every night. Call is usually over the phone and only rarely drags me away from my evenings with them. I fix breakfast and take them to school almost every day - I get help when I am on call and covering frozens for early OR's or have to drive to a small town, but that doesn't happen very often, either.

I know that there are not many readers out there who aspire to do pathology compared to the rest of the medical world - there are certainly a lot sexier specialties out there. But it is fun, it is image based, and although I interact a lot with colleagues, I spend a lot of time by myself and the scope - patients are few and far between. I guess one plus is that I get to save most of my emotional energy for my kids, for which I am very grateful. I have heard that jobs are tough to get these days in this specialty - I can understand why because I see that once you get settled in you are happy and it is tough to leave. I know lots of pathologists that work into their 70's and a few who go into their 80's - it is not a physically strenuous job and I'll bet frozen sections and surgical cases make a good match for Sudoku in staving off Alzheimer's. I watch my dad, a neonatologist in his early 60's, still working all nighters and am thankful that never has been, and never will be me (as a pathologist anyway, I hear with teenagers life gets challenging at night). That being said, most people I know get jobs, even if it is not their first choice of location, and I imagine there are location challenges in lots of specialties.

If you want to work part time, that is another story. Think twice about pathology. Part time path jobs are few and far between, and for those I see that have entered into them they either do too much work without benefits and bonuses and/or are not looked kindly upon by their colleagues even though they are taking a big pay cut for their shorter hours. It seems to have been worked out much better in other specialties - I notice pediatrics where I live, but not pathology. I would love to hear any dissension on this point - my only experience in my field is negative.

I agree with Cutter that being a working parent is a challenge many of us face these days, not just doctors. For women and men out there who aspire to be doctors, and have any interest at all in pathology, the field has my vouch for being a good one to combine with parenting. Our group is half men and half women, and the fathers (they all are - two of us are not mothers) seem to get to participate in parenting a lot more than other specialists I have observed or heard about. But you have to enjoy it - it's not for everyone. I feel lucky that I do.

13 comments:

Thanks for this. I work as a clinical lab scientist now and pathology is on my radar when I get to medical school, among other things. I like interacting with people too though and have an interest in global health so I wondered if it would be a good fit that way. I've found there are options, but fewer than things like ID. I guess I'll find out when I get to the point where I can do rotations, but I appreciate your perspective. It seems like a lot of people don't have a good understanding of what happens in path, or the clinical labs in general.

@Old MD Girl..... I didn't like staring at slides through scopes at first either and I got terribly motion sick, kinda grew on me though. I'm highly visual so that might have something to do with it.

I'm a second-year med student and my husband and I are expecting our first child soon. I have felt drawn toward path from the beginning of this journey and loved reading this blog post - nice to hear about your experiences in the field! Thanks for posting --

I love pathology and have suggested it as a specialty option to several of the MS1s I'm in class with as a good lifestyle specialty. Especially for people who say they like to solve puzzles, but so far no real takers. Pathology needs a better PR department ;-)

OMDG - there are some cadillac scopes out there. Don't knock it until you've tried them.

anon@1:29 - I do get a little patient interaction - fine needle aspirates and apheresis. And as above - scopes are a lot easier to handle when you are the sole driver. I got motion sickness with some attendings pretty bad in training, when I was the passenger.

anon@1:30 - glad you liked it - e-mail me anytime through my blog if you have any more specific questions on your journey.

That Girl - it is a great lifestyle specialty. I kind of like the lack of PR - pathology, I discovered, is a wonderfully well-kept secret.

I concur 1000%. I LOVE being a pathologist and I love the flexibility. I have 5 kids, one of which came during residency, and NO one in my practice gives me a hard time about my maternity leaves (and there have been a lot of them!). Call is once a week, but usually that just means a late night at the office (until 7:30 or so), with rare interruptions thereafter. Sick children are fairly easily accomodated, as we can almost always (unless on the schedule for frozens) read out slides any time of day, buying enough time to rearrange child care or wait for a spouse to come home from work. If there is an at-school emergency (like when my 6 yo broke his arm on the school playground last week!), I can leave work without leaving patients in the lurch (again, as long as I'm not on frozens, which is again about once a week). Yeah, I have to come back in late at night to finish up my work, or super early the next morning, but the flexibility is there, and that is what I love.

Greta - 5 kids, wow! You have my utmost respect. I did get a hard time in residency for doing maternity leave, but mostly from the laziest of male colleagues, no one I really respected, so that was good. I was surprised to get more negative passive aggressive stuff about nursing (i.e. pumping at work).

Your job sounds a smidgen more flexible than mine - I am usually covering some OR or rad suite every day - but since it is not too much trouble to get coverage it makes life pretty easy and I make sure to have lots of paid back up to help when kids are sick or out of school. Yikes - I hope your 6 year old's arm recovers quickly!

As a male (who COMPLETELY respects work-life balance and the importance of parenthood) in a residency program that must put clomiphene in the water, all residents (male and female) should consider this statement:

Just because someone has a perceived negative reaction to you taking maternity (for the um'teenth time) leave does not mean they do not respect the principal behind it. Residency is a grind for everyone, whether they have children or not. The periods of excess work, call (not all path programs have light call), and the reality that the work day doesn't always end right at 5pm can be tough. They wear on everyone emotionally to some degree.

So, when a member of the 'team' is missing and everyone else gets stuck with extra work, they are not always too happy (our program does not require residents to swap call in the event mat/paternity leave, and so everyone else gets a week or two tagged on, as well as service months i.e. grossing/frozens etc).

You should be sensitive and respectful of the fact that your coworkers might not be at exactly the same point as you in their life. Keep in mind that they may have to make sacrifices to 'help' you. I can't even count the number of times I have been stuck at work late handling someone else's cases with clinicians when they have questions after 5pm b/c little miss susie super mom (per usual) flew out the door without politely asking a coworker if they are 'willing' to cover for her. So when 7pm rolls around, and I am just walking out the door, save some of that home cooked meal for me because I had to cancel a date. And yes, I will grit my teeth a little when you and your bird-legged husband decide that residency is the perfect time to procreate because the call I'll be covering for you will likely result in me missing out on more exciting dates. :P

Thank you for this post. It was great to read and answered some of my questions about this very topic. I am a 2nd year newlywed med student; my husband is a 3rd year. We would like to have kids during residency (or so we say now anyway...). Path has been on my radar since before I started med school, but I am torn between several specialties right now. I know/hope 3rd year will help me figure things out, but it is great to hear about life on the other side of training. Thanks for sharing!

i know this is quite late but i wanted to ask because i'm very interested in pathology. i'm interested in pathology because i love what the job entails but i'm worried that pathology would decline because it is possible to send microscope slides abroad to other countries and therefore send jobs to other countries. as a pathologist, do you feel that the job prospects are still good?

I share Justine's sentiments. Pathology seems interesting, but it's future seems quite scary. National labs putting private practices out of business, specialists opening in-office labs, outsourcing digital pathology, and the all too common notion that there a too many grads and no jobs. I don't want to graduate to find that 12 years of my life have gotten me nothing. Does pathology have a bright future?

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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